Mr. John Hayes:

I thank the committee for the invitation to attend today's meeting. I am the chief officer for the community health care organisation, CHO, which covers the five counties of Donegal, Sligo, Leitrim, Cavan and Monaghan. I have attached maps of the area highlighting the main towns and mental health service delivery locations in appendix 1 of my submission. I am responsible for the overall management of community health services in CHO area 1. I am joined by Mr. Padraig O’Beirne, area director of mental health nursing services in the Cavan-Monaghan area and chairperson of the inter-agency steering group which developed the suicide prevention strategy, Connecting for Life, for that area.

The total population of CHO area 1 is 391,281. It is a largely rural area with a low density population and is challenged by relatively high levels of deprivation, a higher percentage of the population with medical or general practitioner, GP, visit cards and limited transport provision compared to national norms. The CHO was established in 2015 and merges Donegal with Sligo-Leitrim and Cavan-Monaghan to form a singular area with four divisions, namely, primary care, social care - which encompasses disability and older people - mental health, and health and well-being. Acute hospital services in CHO 1 are provided by two hospital groups, the RCSI hospitals group and Saolta University Health Care Group.

The organisation and delivery of mental health services in the area are underpinned by national policy, including A Vision for Change. Mr. Leo Kinsella is the head of mental health services in CHO 1. Each geographical area has an integrated area management team chaired by the executive clinical director and includes area directors of mental health nursing, allied health professionals and service user representation. The main building blocks of the service are consultant led multi-disciplinary teams including inpatient, day services, day hospital and residential care; specialist child and adolescent teams; general adult psychiatry teams; psychiatry of old age teams; specialist teams such as community rehabilitation and psychiatry of intellectual disability; and mental health services encompassing primary care, including counselling in primary care, CIPC, suicide prevention supports, youth mental health, Jigsaw, bereavement support and so forth.

In terms of CHO 1 capacity and funding compared with the A Vision for Change recommendations, I have included in my submission the data already provided to the committee by the national director for mental health. I draw the members' attention to the particular challenge regarding child and adolescent mental health services, CAMHS, in the area. For the CAMHS teams servicing the population, we have just over 51% of the clinical staff recommended in A Vision for Change. Regarding the resources for mental health services, I have provided the key staffing data at December 2017. In all, we have 940 whole-time equivalents working in mental health services across the five counties.

In the spreadsheet provided, I have divided the budget for CHO 1 into Sligo-Leitrim, €24.651 million: Donegal, €25.778 million; and Cavan-Monaghan, €23.501 million. Of the overall CHO 1 budget for community health care, 19% of the budget is apportioned to mental health services and within that, some 8.4% is for child and adolescent mental health services.

There are two major capital projects ongoing, one of which is in Blackwater House, St. Davnet’s Campus, Monaghan. This project consists of the redesign, refurbishment and extension of Oriel House to meet the needs of the Blackwater patients. Planning permission has been granted and it is expected that this capital will be completed by the first quarter 2019. There is also a new acute mental health unit to be developed in Sligo. This project will consist of a new build unit on the site of Sligo University Hospital with a target completion date of the third quarter of 2019 with an estimated cost in the region of €11.9 million.

I have included some additional information in the appendices around the keys facts of the demography, health infrastructure and some key developments of the posts and location of centres where mental health service are provided.